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PERMIT APPLICATION <br /> 4 BUILDING I MECHANICAL/PLUMBING l SIGN 1 SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov j cawi.everettwa.gov/permits <br /> Bilue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> -'ROJECT SITE ADDRESS: 500 7 Fli tfrt i I G I PROPER T(TA,,ii: Z 9 052 00 040 99001 <br /> !LEGAL for new construction: Short PletlsubdivisionLot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: }-FO 4t ,*ab R RC t✓ !v TENANT NAME(If Commercial):trL.Q (ADL/0&. /e ji f, <br /> OWNER MAILING ADDRESS: STREET 2 ea. ( I'�.L 6l?C-7Q- AV S r L.: t <br /> ter i <br /> I CRY Lf t'�c�t / STATE U..14 .p G a,'2.0 ( i <br /> TOWNER PHONE: 4Z.3 — (-)— 9 3 3 'OWNER EMAIL: f)/a.4 ;--e `2.)67 of !.'rij., =. <br /> V' <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> cm( STATE ZIP <br /> 'CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> i <br /> !CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): ! <br /> !PRIMARY CONTACT: 0 OWNER ❑CONTRACTOR' OTHER(Please Specify) ./a/4/V/ <br /> !CONTACT NAME: 0/,?//11/1..1 /4-77,_:,g)6.:-&-- CONTACT PHONE: 4Z L •� -3�` :1 <br /> iCONTACT EMAIL: 6,,.--;,,,,,, ,,,d., e 47-7,--...,z= 60 e,,r-. <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: c4 ,7- 5 r7,it.�/Q Contract Price of Work:$ 1,000 1 <br /> Proposed Use of Building: Heat Source: .Gas ❑Electric ❑Other _ i <br /> Building Type: DSFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family 'of Units: IgCommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair DTA. ❑Sign ❑Sprinkler ❑Demolition ❑;Change of Use <br /> DESCRIPTION OF WORK: <br /> I Move toilet k i <br /> 1 <br /> i <br /> ASSOCIATED BUILDING PERMIT;-(if applicable): <br /> I MECHANICAL PERMIT APPLICATION PILi:/MBINO PERMIT APPLICATION 1 <br /> Type of Project: __New Addn Alteration _Repair I Typo of Project: _New _Addn _Alteration _Repair <br /> ofList of Fixtures #OT List of Fixtures $°T ( List of Fixtures #°i List of Fixtures <br /> Fixtures Fixtures .Fixtures Fixtures <br /> AIC-Air Handling Units Heat Pump t+ 'Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub I Urinal <br /> Gas Piping Boiler I Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower I Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal '.Grease Trap <br /> Gas Range Ducting Dishwasher iRoof Drains <br /> Clothes Dryer Hookups I Other: }Clothes Washer 'Medical Gas <br /> Range Hood I 'Water Heater Other: , <br /> Exhaust Fan I I Sink(Service/Bar/Mop/etc.) Other: <br /> I i <br /> SPRINKLER i SUPPRESSION SYSTEM ' <br /> Chemical or Water I No.of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this permit must comply with <br /> current federal,state,and local law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from, the <br /> Building Official before being authorized under any circumstance.i am the owner,or I am authorized by the owner of this properly to perform the work for which application is made, <br /> and i comply with the State Con/rotors Law 18.27 RCW and 296.200.4 ti/AC, <br /> City of Everett Official Use Only <br /> �� / 7,7' ' / fPER1tIIT#t l t\72--OD.--- <br /> rrnerlAuth rizcd n 'h `ty e Date (Revised 9/23/2016) <br />